RESUMO
A 17-year-old female with sickle cell disease status post a recent stem cell transplant and on tacrolimus developed an acute expressive aphasia, dysphagia, and drooling. Brain MRI revealed diffuse restricted diffusion involving the bilateral corona radiata and areas of white matter in the right cerebral hemisphere most consistent with toxic leukoencephalopathy. Tacrolimus serum concentration was high at 19.3 ng/ml (ref 9-12 ng/ml) for which tacrolimus was discontinued. She was neurologically back at baseline 2 days later with the tacrolimus level improving to 8.2 ng/mL. Following discontinuation and the declining trend of her tacrolimus levels the patient returned to her neurologic baseline and was subsequently switched to mycophenolate mofetil for GVHD immunosuppression.
RESUMO
BACKGROUND: Enlarged lymph nodes are a common complaint in a Pediatrician's office. Diagnosis of reactive lymphadenopathy secondary to infectious, inflammatory, immune dysregulation calls for clinical investigation, including a thorough history, physical exam, imaging, and less often, a biopsy of the lymph node. Here we discuss a rare presentation of extensive generalized, chronic, waxing, and waning lymphadenopathy diagnosed as Progressive Transformation of Germinal Centers (PTGC) and the course of illness over eight years follow up period. DISCUSSION: Progressive Transformation of Germinal Centers (PTGC) is considered a benign condition, but extensive recurrent generalized lymphadenopathy in a very young child has not been reported before. This case demonstrates the importance of long-term follow-up and tailoring the diagnostic work-up and management based on new signs and symptoms. Here we focus on the clinical considerations and management of complex presentation of a common clinical finding.
RESUMO
The collision-induced dissociation of protonated hydroxyalkylamino-1,4-naphthoquinones depends strongly on the structure of the substituent [NHCH(2)(CH(2))(n)OH, n = 1-5; or NHCH(2)CH(CH(3))OH] on the quinone ring. Protonated naphthoquinones with an unbranched hydroxypropylamino side chain (n = 3) undergo facile and characteristic CH(2)O loss, whereas isomeric [M + H](+) ions with a branched hydroxypropylamino side chain do not. When n = 1, CH(2)O elimination occurs less readily, accompanied by CH(3)N loss, thus allowing this shorter side chain to be identified. Higher homologous species (n = 3-5) do not expel CH(2)O, but instead eliminate C(n + 1)H(2n)O, C(n + 1)H(2n + 2)O and (for n = 5) C(2n + 1)H(2n + 1)O.
